Monday, November 4, 2013

New heart valve shows high survival rates in study, Loyola researchers say

MAYWOOD, Ill.  – Loyola University Medical Center is the only Chicago hospital participating in a landmark clinical trial of an artificial aortic heart valve that does not require open heart surgery.

First results from the trial were announced at the Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium in San Francisco. Results were positive, with high survival rates and low rates of stroke.

“This is a major breakthrough,” said Fred Leya, MD, co-principal investigator at the Loyola site. “Not only did patients live longer, but their quality of life improved substantially.” The other co-investigator at Loyola is Mamdouh Bakhos, MD.

The heart valve is called the Medtronic CoreValve® System. It is deployed with a catheter, which is inserted into an artery in the groin and guided up to the heart. Once in place, the artificial valve takes over the function of a diseased valve.

“It saved me a great deal of pain and suffering from not having to have my chest cracked open,” said Loyola patient Martin Rogus, who participated in the clinical trial. While recovering from the valve placement, he said, “It almost felt like they didn’t do anything."

Rogus said that before receiving the new valve, he could not walk a single block without having to stop and catch his breath. Now he can walk a mile slowly, without stopping. “It’s been a great gift,” he said.

The valve is being studied in patients with severe aortic stenosis. This condition occurs when the heart's aortic valve is narrowed, restricting blood flow from the heart to the body. The valve doesn't open properly, forcing the heart to work harder to pump blood.

Symptoms include fatigue, dizziness, chest pain/pressure, heart murmur, shortness of breath during activity, heart palpitations and fainting. Aortic stenosis can lead to heart failure and death. About 100,000 people in the United States have aortic stenosis. Currently in the United States, the standard treatment is to replace the aortic valve through open-heart surgery.

The initial phase of the trial included 471 patients at 40 centers who were extremely frail and had complex medical problems that made them too sick for open heart surgery.

One year after implantation, 76 percent of the patients were still alive, a remarkable result considering how ill they were. And only 4.1 percent had experienced major strokes within that first year, which was significantly lower than expected.

The valves worked well, with strong blood flow and low leakage rates.

There was a huge improvement in patients’ quality of life, as measured on a 100 point scale. The scores of patients who had their implant for one year improved 27.4 points on the KCCQ scale. (By comparison, 5 points is considered important and 20 points is considered a very large improvement.)

Investigators are expected to report on the trial’s other study of patients who are not as frail as those in the initial group. Half of these new patients have been randomly assigned to receive CoreValve and half have been assigned to conventional open heart surgery.

More than 45,000 patients in more than 60 countries have received the CoreValve System. In the United States, use of the device is limited to clinical trials.

Leya is a professor of medicine and director of Interventional Cardiology, and Bakhos is professor and chair of Thoracic and Cardiovascular Surgery at Loyola University Chicago Stritch School of Medicine. J. Michael Tuchek, DO, worked with Leya in implanting the device. Tuchek is a clinical assistant professor in the Department of Thoracic and Cardiovascular Surgery.

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. Loyola University Medical Center’s campus is conveniently located in Maywood, 13 miles west of Chicago’s Loop and 8 miles east of Oak Brook, Ill. At the heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is a national Catholic health system with an enduring legacy and a steadfast mission to be a transforming and healing presence within the communities we serve. Trinity is committed to being a people-centered health care system that enables better health, better care and lower costs. Trinity Health has 91 hospitals and hundreds of continuing care facilities, home care agencies and outpatient centers in 21 states and 119,000 employees.